The Jakarta Post
The majority of nurses at general hospitals and COVID-19 referral hospitals carry a heavy burden, as they are not only fighting on the frontline against the disease, but are also struggling with personal financial difficulties caused by the pandemic.
Amid the COVID-19 outbreak, most hospitals are reportedly suffering financially due to a decrease in the number of patients, while their operational costs remain high.
Ratna, not her real name, discussed the experiences of herself and her colleagues while treating COVID-19 patients in the intensive care unit of the Fatmawati General Hospital in South Jakarta.
The 26-year-old nurse, along with around 60 of her colleagues at the ICU as well as several other medical workers at the state-run hospital, saw cuts to their Idul Fitri holiday bonuses (THR). Such bonuses are traditionally sourced from the state budget and the hospital’s profit.
However, because of the pandemic, Ratna said the hospital’s management had told its employees that it had been forced to cut their bonuses and paychecks because of profit loss and increased operational costs.
"This year, the hospital did not allocate any of its budget for our bonuses. The cut applied not just to contract-based workers like myself, but also permanent employees,” she told The Jakarta Post on Tuesday.
Ratna said her holiday bonus was cut to Rp 1.5 million (US$102).
Fatmawati Hospital spokesperson Atom Kadam confirmed the bonus cuts, arguing that the decision did not violate Government Regulation No. 24/2020 on holiday bonuses. “[The regulation] stipulates that the source of [holiday bonus] money is from the state budget,” he said.
Besides receiving a smaller bonus, Ratna also suffered a pay cut.
“[My salary] was cut 30 to 40 percent last month. My salary was also cut this month, although not by as much,” said the nurse, who has a bachelor of science degree.
Ratna, who has not been home in two months because of her work, said she failed to understand the hospital’s reason for cutting bonuses and salaries.
She said prior to the past three months of the health crisis, the hospital had seen a high bed occupancy rate, which to her understanding, contributed to the hospitals income.
"Before January, I treated patients in [low] class 3 facilities, which were fully occupied following the announcement of the government's plan to hike BPJS Kesehatan’s [Healthcare and Social Security Agency] premiums.
“Our [hospital’s] bed occupancy rate reached its maximum at that time and we even ran out of beds. We experienced no shortage in patients for the last nine months [before the virus outbreak], at least,” said Ratna.
Amid the pandemic, the Health Ministry has said the bed occupancy rate of most hospitals nationwide has dropped 20 to 50 percent.
By comparison, Ratna described the situation faced by most nurses in one of the country’s main COVID-19 referral hospitals. She said permanent staff nurses at the hospital were suffering from financial difficulties after the hospital eliminated its meal and other allowances due to the dropping bed occupancy rate. They also experienced holiday bonus cuts, she added.
To support healthcare professionals during the pandemic, the government is providing monthly incentives of Rp 15 million for medical specialists, Rp 10 million for physicians and dentists, Rp 7.5 million for nurses and Rp 5 million for medical staffers.
However, Ratna said she had yet to receive the money. She said the hospital had to verify an employee’s attendance, punctuality and the extent to which they were exposed to the virus, before distributing the funds.
As of Tuesday, the Indonesian Nurses Association (PPNI) had recorded 21 complaints from nurses across the country regarding a perceived lack of appreciation stemming from holiday bonus cuts and low wages, among other reasons, during the pandemic.
PPNI secretary Maryanto said the reports came from nurses at state hospitals, private hospitals, clinics and community health centers (Puskesmas).
“The cash flow of state hospitals may have been affected by COVID-19 related expenses that have placed a burden on the regional budget [APBD]. Nevertheless, private and state hospitals that are not COVID-19 referral hospitals have also suffered from a low number of patients over fears of infection,” he said.
The organization has urged employers to give priority to nurses, as healthcare workers on the frontline were exposed to hazards that put them at risk of infection.
Nurses in some hospitals, according to the organization, had also reported on their fears they would lose their jobs, as private hospitals moved to furlough them or reduce their hours due to a loss of revenue from the outbreak.
The Indonesian Private Hospital Association (ARSSI) said on Wednesday that the government had yet to pay full BPJS Kesehatan claims submitted by 201 private hospitals handling around 3,373 COVID-19 patients.
"The government has only paid 50 percent and we are still waiting for BPJS Kesehatan to verify the claims. The hospitals' cash flow is down, which has affected holiday bonuses and wages," ARSSI secretary-general Ichsan Hanafi said, adding that if the remaining claims were not paid immediately it could lead to layoffs, especially of contract-based workers.
The Health Ministry's director of referral health services, Tri Hesty Widyastoeti Marwotosoeko, said the government was still waiting for BPJS Kesehatan to verify the claims before disbursing money to hospitals.